Broadening conceptions of medical student mistreatment during clinical teaching: message from a study of “toxic” phenomenon during bedside teaching

Figures & data

Table 6 Themes identified in medical students’ comments during semi-structured interview, with illustrative quotations

1. Threatening to learn

Example quotation:

a. “To me it reflects a lack of teaching expertise by those teachers involved … because it demoralises you and does not help students and the teachers. Possible they don’t know how to teach in any other way.”

b. “After being humiliated for the second time, I don’t want to go for the ward rounds sometimes and at the end of the day, I really feel bad about my choice of studying for this career.”

2. Traditional practice in the culture of medical education

Example quotation:

a. “I get the feeling it’s an age long practice. It’s to motivate you to keep studying, to become confident in yourself. So I think to see how we handle pressure in front of people, what you will face for the rest of your career … I’ve heard colleagues complain about it, but I like it”.

b. “This culture of making fun of students in front of your peers and humiliating you because you say the wrong answer has to stop.” “You can only learn so much from a teacher who is friendly.”

3. Group and learning environment facilitators

Example quotation:

a. “It all boils down to everything, I mean the teachers, nurses, residents and other staff, all professional groups on different occasions exhibit this behaviour and am developing thick skin. For example, some nurses feel superior when a student cannot perform a procedure and humiliated by attending consultant.”

b. “You are just new in the clinical year and you are expected to know everything. Competition rather than learning is promoted among us students with bedside questions and belittling. You try to avoid been questioned in front of your peers and other ward staff.”

4. Current intervention strategies

Example quotation:

a. “They said we can report. Report a teacher that will eventually examine you for promotion? Complain to whom? Students are at the bottom of the ladder in this profession so we get used to it.”

b. My own opinion is that the present methods to stop this practice is just a way to show people that, officially, the medical college is doing something about it. Has it stopped it? The answer is No.”

Table 1 Distribution of the respondents by sex and age (N=47)

Variables	N	%
Sex
Male	24	51.1
Female	21	44.6
Not recorded	2	4.3
Age (years)
20–25	15	31.9
26–30	22	46.8
31–35	9	19.1
Not recorded	1	2.1

Figure 1 Prevalence of “toxic” phenomenon among the respondents.

Table 2 Frequency of “toxic” experiences among students and their disclosure pattern

Frequency of “toxic” experiences among respondents	N	%
Once	16	40.0
Occasionally	20	50.0
Frequently	4	10.0
Reporting/discussing toxic experiences
Report to someone	24	60.0
Did not report	16	40.0

Figure 2 Level of satisfaction of “toxic” victims with the outcome of their disclosure after disclosing.

Table3 Pattern of “toxic” disclosure among respondents by sex

People reported to	Sex						Total
	Male		Female		Missing sex
	N	%	N	%			N	%
Dean of students	1	7.7	0	0.0	0	0.0	1	4.2
Designated counselor/hall master/matron	0	0.0	0	0.0	0	0.0	0	0.0
Other medical school administrators	0	0.0	0	0.0	0	0.0	0	0.0
Faculty member	0	0.0	0	0.0	0	0.0	0	0.0
Fellow students	11	84.6	8	89.8	2	100.0	21	87.4
Parents	1	7.7			0	0.0	1	4.2
Friends	0	0.0	1	11.1	0	0.0	1	4.2
Total	13	54.2	9	37.5	2	8.3	24	100.0

Table 4 Distribution of respondents by their reason for not discussing their “toxic” experience by sex

Reasons	Male		Female		Total
	N	%	N	%	N	%
The incident did not seem important enough to report	4	44.4	3	42.9	7	43.8
I resolved the issue myself	3	33.3	1	14.3	4	25.0
I did not think anything would be done about it	3	33.3	1	14.3	4	25.0
Fear of reprisal	2	22.2	1	14.3	3	18.8
I did not know what to do	1	11.1	2	28.6	3	18.8

Table 5 Perception of respondents on the adverse effects of public belittlement on students

Variables	N	%
Belittlement behavior had adverse effects (N=40)
Yes	24	60.0
No	16	40.0
Reasons why belittlement had no adverse effect (N=16)
I thought it is not an offensive behavior	2	12.5
I thought it will make me study harder	6	37.5
It is part of the culture of medical education	7	43.8
Made me stronger	6	37.5
Verbal abuse is part of the culture of bringing up children	0	0.0
I will also do the same if I become a clinical teacher	0	0.0
Adverse effect of public belittlement on students (N=24)
Made me miserable and depressed	7	29.2
Felt anger/rage	9	37.5
Caused stress	3	12.5
Created poor learning environment	8	33.3
Negative feelings toward the clinical teacher	15	62.5
Made the posting uncomfortable	14	58.3
Resort to alcohol/smoking	2	8.3
Caused depression	5	20.8